Provider Demographics
NPI:1144952342
Name:DOUGHTY, JAMIE DANIELLE (NP)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:DANIELLE
Last Name:DOUGHTY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:DANIELLE
Other - Last Name:NORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2109 DOCTORS PARK DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47203-2224
Mailing Address - Country:US
Mailing Address - Phone:812-372-2245
Mailing Address - Fax:812-375-2156
Practice Address - Street 1:2109 DOCTORS PARK DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47203-2224
Practice Address - Country:US
Practice Address - Phone:812-372-2245
Practice Address - Fax:812-375-2156
Is Sole Proprietor?:No
Enumeration Date:2022-06-27
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71013271A363LF0000X
IN01072315A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily